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Reham Al-harataniReham Al-haratani 300075300075
•AGE: 42 years old
•NATIONALITY: Philipino •GENDER: Female
Wants to treat her carious teeth.
MEDICAL HISTORY:
•Rheumatoid Arthritis – Ankle Swelling.. “Voltaren”.
•Hypothyroidism.
•Episodes of headaches and fainting.
•1996, inflammatory lymphadenitis..admitted for surgery.
Extra-oral Examination:
Dental History:
o Bleeding gum.
o Several extractions.
o some fillings.
o TMJ dislocation.
Family History:
oCardiac arrest.
oHypertension.
A.GENERAL : Insignificant
B. Extra-oral : Insignificant
C. Intra-oral Examination :
Pigmented lesion discovered. Otherwise, normal.
INTRA-ORAL EXAMINATION
So…regarding the buccal mucosa (lesion):
-Location: Irregularly distributed, bilaterally.
-Texture:Smooth..Does not disappear upon rubbing nor stretching.
-Color & Shape: Brown pigmentations + white striations (characteristic Wickham’s striae).
-Size:
Brown pigm. All over.
White striations extend from retromolar area up to the commissures. - Lingual gingiva of lower anterior teeth.
-Painless
- No discomfort upon eating nor swallowing.
lichen planus. (Reticular form) with areas of pigmentation.
lichenoid reaction
Physiologic pigmentation.
ORAL LICHEN PLANUS
Reticular asymptomatic type..
مرض الحزاز الفموي المنبسط
Thyroid Function Test to check the hormonal status:
Results:
Within normal range.
Last follow-up was on Sunday 8 - 4 - 2007
Showing stability without any progression
Treatment Plan…Further follow up every 6 months - 1 year
Background: Autoimmune chronic mucocutaneuos condition.
Age: middle-aged personsGender: female predilection
Etiology: T-cell-mediated autoimmune disease.
Clinically:Types Reticular ASYMPTOMATIC
Erosive (ulcerations) Atrophic (erythema)
Bullous (blisters) SYMPTOMATIC – Pre-malignant
OLP associated with patchy brown melanin deposits
28 % have coincident skin lesions..polygonal papules with white lines on surface
HISTOLOGY: 1. Hyperkeratosis.
2. Acanthosis.
3. Saw-tooth Rete Ridges (shortened).
4. Basal cell degeneration (liquefaction).5. Band-like lymphocitic infiltration.
Management :
Asymptomatic type No pharmalogical intervention
Symptomatic Corticosteroids
Topical orabase
Retinoids
+ biopsy and examination every 4-6 months.
Aim : investigate occurrence of skin and oral LP in patients with CLD..
Info. : when 2003
where KAUH
who Dr. Maha Abdel-salam
Dr. Rabab Feteih
Methods Results
94 with CLD
78 HCV +ve
24 HBV +ve
OLP detected in 5 pts
4 HCV +ve
1 HBV +ve
2. Biopsies obtained Confirmed the clinical diagnosis
3. Liver function tests Insignificantly associated
4. Statistical analysis,
assess reliability of liver
enz. to predict OLP
Not predictive
Methods Results
94 with CLD
78 HCV +ve
24 HBV +ve
OLP detected in 5 pts
4 HCV +ve
1 HBV +ve
2. Biopsies obtained Confirmed the clinical diagnosis
3. Liver function tests Insignificantly associated
4. Statistical analysis,
assess reliability of liver
enz. to predict OLP
Not predictive
Methods Results
94 with CLD
78 HCV +ve
24 HBV +ve
OLP detected in 5 pts
4 HCV +ve
1 HBV +ve
2. Biopsies obtained Confirmed the clinical diagnosis
3. Liver function tests Insignificantly associated
4. Statistical analysis,
assess reliability of liver
enz. to predict OLP
Not predictive
Conclusion: OLP … an extrahepatic manifestation of CLD..
Comparison :
when 1997 where Dammam
Differences:
1. Participants diagnosed 1st with OLP then CLD was studied..
2. Claimed a correlation between liver enzymes and OLP
Main conclusion:
OLP CLD Dentist Physician
HCV and HBV screening results...
References:Abdel-salam M. , Feteih R. “Oral Lichen Planus in Patients With Chronic liver disease”. Egyptian Dental Journal, 49, 953 - 958, April, 2003.
El-rifaei A., Fathalla S. “The Prevalence of Indices of HC and HB infection in Patients With OLP in Eastern Saudi Arabia”. Saudi Society of Family and Community Medicine,1997.
Sugerman P. et al. “Oral Lichen Planus”.2005.www.e-medicine.com
Neville B.W. et al. “Oral and Maxillofacial Pathology”.(2nd edition), chp.16, pg 680-685..2003
